Emotional Contagion - You're Bringing Me Down Man!

We've all come across people who are described as "fun suckers" or alternatively "light up the room" whenever they are present. These are both extreme examples of how a person's mood can influence others around them. Away from the extremes we are still very much influenced by the emotions of those around us; family , friends and work colleagues. As well as influencing how we feel our social networks can also influence what we do and the lifestyle behaviors we choose. Research from the Department of Healthcare Policy at Harvard published a few years ago showed that a person's chance of becoming obese in any given time frame increased by 57% if he or she had a friend who became obese during that same period. Their research showed this to be a very consistent effect across the network and held true for other lifestyle related behaviors such as smoking and heavy alcohol consumption.

This research paper, just published in PLOS One, by researchers at UC San Diego looked at Facebook status update data between January 2009 and March 2012 to determine whether status updates by users had a discernible affect on the emotions of their friends who were not in the same city as them. There's some pretty high end math in the paper, but putting that aside they showed that rainfall directly influenced the emotional content of the status messages of individuals and that this in turn affected the emotional content of the status messages of their friends in other cities not experiencing rainfall. The researchers used the Linguistic Inquiry and Word Count (LIWC) software to assess the positivity and negativity of messages posted.  

This is fascinating stuff, and shows that we don't have to be in the same physical location as someone to potentially influence how they feel (or indeed be influenced by how they feel). The question arises whether this affect through a digital social network is confined just to emotion or whether, like in physical social networks, it also extends to influencing others' actions and choices?

As many of us spend increasing proportions of our waking hours communicating by digital means, and possibly less time than we used to in face-to-face interactions, this is certainly an area that warrants further investigation. In addition it bodes well for digital social networks as a catalyst for positive health behavior change in society.  

As an addendum, when I run this blog post through the free version of the LIWC software I get a count of 1.27 positive emotions to 0.51 negative emotions. So all in all pretty happy!  

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Getting Your Wellness On

One of the little known, or at least little discussed, elements of the Patient Protection and Affordable Care Act (ACA) was establishing the annual wellness visit as a fully covered benefit for all Medicare beneficiaries. Since January 2011 CMS covers an initial welcome to Medicare wellness visit and then an ongoing annual wellness visit (AWV), and reimburses appropriate healthcare professionals for conducting the visit.

Prior to the patient attending the AWV they are required to complete a health risk assessment (HRA) questionnaire that specifically covers a variety of lifestyle and medical risk factors that are known to contribute to future disease and ill health. HRAs have been used to inform and assess workplace health promotion initiatives for decades, however they are relatively under-utilized in the provider setting and it is not clear exactly why this is.

A research study published in 2006 showed that Medicare enrollees who completed an HRA had between $101 and $648 per year lower healthcare costs compared with those that did not. In addition, Dee Edington and colleagues showed that by using an HRA it is relatively straightforward to segment the population into groups according to risk , which closely correlates with future care utilization and costs.

The great thing about the modern internet and mobile technology is that, even compared to a few years ago, it is possible to deliver so much more personalized and relevant information and recommendations than previously. As well as making people think more deeply about their health and lifestyle an HRA is a great vehicle by which to deliver actionable and relevant information to people.

Imagine getting everyone attending a medical facility to complete an HRA prior to their visit and having a summary of their data available to the provider of care to view at the time of the visit? Even if the provider were to spend just a few seconds giving lifestyle recommendations during the consultation we know that such a "brief intervention" has profound effects on motivating individuals to make changes. Couple this with the output from the HRA containing real and actionable recommendations for the patient; for example the telephone number to call for the quit smoking service or the person to contact at the local YMCA for beginners activity classes, and you have a very powerful instrument of change.

Well...this is exactly what we've been doing with a number of our clients across the US and also the UK. The initial results we are seeing are extremely promising. With one integrated delivery organization that we have been working with since 2012 we have seen 67% of respondents stating they had made lifestyle changes based on the information contained in their HRA report. In addition, 77% of respondents stated that they found the information about local services and resources relevant and useful and almost 20% of them actually made contact with one of the recommended institutions.

With increasing emphasis being placed on managing outcomes and costs in defined populations this is a "no brainer" in terms of engaging patients in a dialog about their health and making them active participants in improving it.